title: Henoch-Schönlein purpura nephritis with nephrotic state in children: predictors of poor outcomes.
abstract: Nephritis develops in 18-81% of Henoch-Schönlein purpura patients, and the long-term outcomes of this nephritis show great variation. A nephrotic state at disease onset has been proposed as a predictor of poor renal outcomes. We studied 42 children with Henoch-Schönlein purpura nephritis (HSPN) who presented with a nephrotic state during the early phase of the disease. The median age of the patients at the time of diagnosis was 7.4 years. The median follow-up period was 6.2 years. Twenty-five children (60%) made a complete recovery; nine (21%) progressed to end-stage renal disease. Multivariate logistic regression analyses revealed that the nephrotic state lasting for more than 3 months had a significant effect on renal outcomes (odds ratio 11.6; 95% confidential interval, 1.16-348.4; p = 0.03), whereas initial renal insufficiency, renal pathological findings, age at onset, and types of treatment did not. These findings indicate that clinical presentation, particularly duration of the nephrotic state, is related to long-term outcomes in HSPN patients with nephrosis. Our results also indicate that the therapeutic options for HSPN patients with a nephrotic state should be based on the clinical presentation rather than on the initial pathological findings alone.
authors.affiliation: Department of Pediatrics, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, 240-0062, Japan. hitoshiwakaki@aol.com
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Wakaki
authors.forename: Kenji
authors.initials: K
authors.lastname: Ishikura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hataya
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hamasaki
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Sakai
authors.forename: Nahoko
authors.initials: N
authors.lastname: Yata
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Kaneko
authors.forename: Masataka
authors.initials: M
authors.lastname: Honda
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications / Q000175:diagnosis*; D007668:Kidney / Q000473:pathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology*; D008297:Male; D009393:Nephritis / Q000150:complications / Q000175:diagnosis*; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000209:etiology; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors